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Time Reduction or Waste Production?
Get PDFPICOT Question: In adult patients arriving at the Emergency Department, does proactively conducting standard laboratory tests prior to provider assessment, as opposed to waiting for provider instructions, lead to a reduction in the overall length of stay during a single visit?https://knowledgeconnection.mainehealth.org/nurseresidency/1127/thumbnail.jp
Midazolam in the treatment of catatonia: A case series
No full textPURPOSE: Catatonia is a condition estimated to affect 10% to 15% of patients admitted to psychiatric hospitals. It is characterized by motor and behavioral changes including staring, mutism, changes in muscle tone such as waxy flexibility, posturing, and changes in movement patterns. Benzodiazepines are considered a first-line treatment option for catatonia, and most people achieve symptom remission within days. Most literature supports use of lorazepam for treatment of catatonia, and there is limited data about use of other benzodiazepines such as midazolam. SUMMARY: Here we report a 6-person case series of patients admitted to an inpatient psychiatric unit with catatonia and treated at least in part with midazolam. We describe the safety outcomes such as respiratory depression, hypotension, and bradycardia, as well as the effectiveness of treatment. In this case series, all patients were treated with midazolam with or without other benzodiazepines and/or electroconvulsive therapy (ECT) during their inpatient stay for catatonia. Overall, these 6 patients tolerated doses of intravenous (IV) midazolam ranging from 4 to 32 mg daily and up to 48 mg daily of oral midazolam. There were no clinically relevant episodes of respiratory depression, hypotension, or bradycardia. Midazolam appeared to be at least partially effective as an adjunctive therapy in 5 of the 6 cases, but vast improvement was seen after ECT initiation. CONCLUSION: Midazolam may be an alternative or adjunctive therapy for the treatment of catatonia in circumstances where IV lorazepam is unavailable. More rigorous studies should be performed to more clearly elucidate the safety and effectiveness of midazolam as monotherapy and when used in combination with ECT early in the treatment of catatonia
Comparable peri-transplant mortality and incidence of febrile neutropenia after high-dose melphalan and autologous stem cell transplantation in patients with plasma cell dyscrasias treated as outpatient versus inpatient.
No full textPostoperative outcomes of antireflux surgery in lung transplant recipients.
No full textBACKGROUND: Gastroesophageal reflux disease (GERD) is a risk factor for aspiration and lung allograft rejection. Antireflux surgery (ARS) can be performed for these patients to improve GERD and to abate lung function decline. Accordingly, this study aimed to compare the efficacy of different accepted ARS techniques in lung transplant populations.
METHODS: A single-center retrospective cohort study of lung transplant recipients who underwent ARS between 2011 and 2023 was performed. GERD symptoms were based on proton pump inhibitor (PPI) usage postoperatively. In addition, pulmonary function testing, postoperative complications, dysphagia complaints, and endoscopic or surgical revisions were evaluated and compared using chi-square and Wilcoxon rank-sum tests. A P value of ≤.05 was considered significant.
RESULTS: A total of 96 patients underwent Nissen (49.0%), Toupet (46.9%), or Dor (1.0%) fundoplication or magnetic sphincter augmentation (3.1%). Compared with patients who underwent Toupet fundoplication, those who underwent Nissen fundoplication had increased rates of PPI usage at 3 months (54.8% vs 93.0%, respectively; P \u3c .001) and 6 months (40.5% vs 90.7%, respectively; P \u3c .001) postoperatively, with no significant differences at the most recent follow-up. Between patients who underwent Nissen fundoplication and those who underwent Toupet fundoplication, differences in the rates of postoperative dysphagia (45.7% vs 42.2%, respectively; P =.678), endoscopic dilation (17.4% vs 22.2%, respectively; P =.219), and revisional surgery (8.7% vs 2.2%, respectively; P =.140) were statistically insignificant. No significant differences in forced expiratory volume in 1 second (FEV1) or the median FEV1% change before and after ARS were identified between Nissen and Toupet fundoplications (FEV1: 1.98 vs 2.04 L, respectively; P =.470; FEV1% change: 1.96% vs 0.98%, respectively; P =.524).
CONCLUSION: Considering the lower PPI usage at 3 and 6 months after ARS, Toupet fundoplication was superior to Nissen fundoplication in terms of decreasing PPI use in lung transplant recipients. Postoperative dysphagia, reintervention, and pulmonary function outcomes were similar between patients who underwent Toupet fundoplication and those who underwent Nissen fundoplication
From Surviving to Thriving: Understanding and Managing Late Effects of Pediatric Cancer Treatment
No full textCME available for 1 year after presentation
CME Text Code: 97044
In order to claim CME credit, please complete an evaluation in CloudCME for each presentation.https://knowledgeconnection.mainehealth.org/pediatrics_gr/1086/thumbnail.jp
Scheduled Ambulation Twice Per Shift to Reduce Hospital-Acquired Delirium
No full textIn older adult inpatients ages 65 and older on a medical-surgical telemetry unit, does scheduled ambulation twice per shift with staff assistance, compared to as-needed ambulation, reduce the incidence of hospital-acquired delirium during hospitalization?https://knowledgeconnection.mainehealth.org/nurseresidency/1139/thumbnail.jp
Concentrations of per- and polyfluoroalkyl substances (PFAS) in private well drinking water and serum of individuals exposed to PFAS through biosolids: The Maine Biosolids Study
No full textPer- and polyfluoroalkyl substances (PFAS) are synthetic and persistent chemicals that can contaminate food and water systems and have lasting negative implications for human health. We described paired residential well water and serum PFAS concentrations among adults residing where PFAS-contaminated biosolids were historically applied to farmland as fertilizer. In 2023, we measured 7 PFAS in serum from 145 participants who had up to 28 PFAS measured in their well water within the 3 prior years due to proximity to a biosolids application site. Participants were median(interquartile range) 63(15) years, 58 % were female, 71 % lived less than a mile from a site of biosolids application, and 58 % had well water PFAS levels exceeding the Maine Interim Drinking Water Standard (∑6 legacy PFAS ≥20 ng/L). In well water, PFOA, PFOS, PFHxA, PFHpA, PFPeA, PFBA, PFHxS, and PFNA were detectable in \u3e50 % of wells, and 21 unique PFAS were detected. Well water concentrations were highest for PFOA [GM(GSD) 13.6(20.1) ng/L]. In serum, detectable PFAS included PFOA [GM(GSD) 6.1(4.9) ng/mL)]; PFOS [8.3(4.1) ng/mL], PFHxS [1.4(2.5) ng/mL], PFNA [1.3(3.8) ng/mL], PFDA [0.40(4.1) ng/mL], and PFUnDA [0.17(2.8) ng/mL]. Of PFAS measured and highly detectable in both serum and water, PFOA had the strongest inter-matrix correlation (0.72); other PFAS had moderate correlations (0.32-0.33). In conclusion, individuals living in an area with historic application of PFAS-contaminated biosolids had elevated and highly correlated PFOA concentrations in water and serum. Other serum PFAS were elevated but moderately correlated with water concentrations, suggesting potential non-water exposure pathways
Evaluation, Stabilization, and Transfer of Pregnant and Postpartum Patients Presenting to Emergency Departments Without Inpatient Obstetric Services
No full textMore than 50% of rural critical access hospitals in the United States no longer provide inpatient obstetric services. As more hospitals close their hospital-based obstetric services, emergency physicians must still be ready to care for pregnant patients who present emergently for care. Ideally, this will include immediate medical screening examination, stabilization and transfer to a hospital with obstetric services. In other circumstances, it will result in the need to provide basic obstetric emergency care for conditions such as unanticipated delivery, postpartum hemorrhage, eclamptic seizure, and neonatal resuscitation. Emergency physicians working in hospitals without inpatient obstetric services need to have knowledge of both the closest obstetric unit they can transfer a full-term patient for obstetric triage and delivery, and where they can transfer a preterm patient at any gestational age. Level I Obstetrical Units (low-risk units) can typically accept patients with more than 37 weeks gestation. Regional maternal centers (Level III/Level IV) can typically accept any gestational age. It is critical for emergency physicians working in facilities without inpatient obstetrics to be familiar with both resources in their catchment area (eg, nearby low-risk and regional high-risk centers). This article examines the emergency physician\u27s role in evaluation, stabilization, and transfer of pregnant and postpartum patients seeking emergency medical care at facilities without inpatient obstetric services
Implementing the CARD System Distraction Techniques in Pediatric Primary Care – A Practice Improvement Project
No full textProblem: Increasing vaccine uptake is an urgent priority in public health. Often pain and fear are reasons for vaccine refusal, leading to lower vaccine uptake. The Comfort, Ask, Relax, Distract (CARD) system was developed to improve the vaccination experience and has been successfully implemented in school-based vaccination clinics and community pharmacies. The clinic that served as the site of this practice improvement project was routinely using 3 of the 4 CARD techniques (Comfort, Ask, and Relax), but was not offering evidence-based distraction methods to patients eligible for vaccination.
Approach: This practice examined the feasibility and acceptability of implementing CARD distraction methods into the clinical workflow of a pediatric primary care setting. For a 90-day period between September and December 2024, distraction methods were offered to eligible patients who accepted vaccines at their appointment. Also, data were collected from the electronic health record, including the percentage of eligible patients who were offered distraction techniques, who accepted distraction methods, and who were actively engaged with the distraction methods just before vaccine administration.
Outcomes: Of the 58 patients who accepted vaccines during their visit, 32 (55.2%) were offered CARD distraction techniques by the provider. There was 100% caregiver acceptance among patients who were offered the distraction techniques. Before their vaccine administration, 30 of 32 (93.8%) children were engaged with CARD distraction methods.
Next Steps: This project showed that CARD can be integrated into pediatric primary care. Further research is needed to assess equity in offering distraction techniques and how CARD influences patients’ perceived pain and fear during vaccine administration